(326) Comparison between expectant and intervention management in women attempting trial of labor after cesarean section

Thursday, February 9, 2023

10:30 AM – 12:00 PM

Objective: To compare the outcomes between expectant and interventional management in patients attempting trial of labor after cesarean section (TOLAC).

Study Design: In this retrospective single-center cohort study, we obtained information regarding women attempting TOLAC that delivered between January 2008 and April 2022. We compared induction of labor (IOL) performed at 38+0-38+6 weeks` gestation (Group A), 39+0-39+6 weeks` gestation (Group B) and 40+0-41+0 weeks` gestation (Group C) with expectant management (Group D). The primary outcome was the repeated cesarean delivery (CD) rate and the secondary outcomes included uterine rupture rates in addition to other adverse maternal and neonatal outcomes.

Results: A total of 3248 patients attempted TOLAC during the study period of which 1856 required IOL. Repeated CD rates were significantly lower in patients of Group D compared with patients of groups A+B+C (11.5% vs. 28.1%, p=0.009), though no significant difference was noted compared only with group B (11.5% vs. 19.3%, p=0.072). The rate of repeated CD due to non-progression of labor was significantly lower in group D compared with the groups A+B+C (29.3% vs. 58.4%, p=0.019) but the rate of repeated CD due to fetal distress was significantly higher in group D compared with the IOL groups A+B+C (61.2% vs. 24.3%, p=0.012). The rate of repeated CD due to patient`s request during labor was significantly lower in the group D compared with IOL groups A+B+C (9.5% vs. 17.3%, p=0.023). There were no significant differences in uterine rupture rate comparing between the groups. The rate of chorioamnionitis (6.2% vs. 11.8%, p=0.028) and the rate of postpartum hemorrhage (5.9% vs. 9.9%, p=0.038) were significantly lower in group D compared with the IOL groups A+B+C. No other significant differences were found.

Conclusion:

Our data suggests a better outcome for women undergoing expectant management for TOLAC . However, prospective randomized trials are needed to confirm our findings.

Primary & Presenting Author(s)

Roy Lauterbach, MD
Department of Obstetrics and Gynecology, Mount Sinai Hospital, Toronto, Canada
Toronto, Ontario, Canada

Coauthor(s)

Naphtali Justman, MD, MPH
Rambam Health Care Campus
Haifa, Israel, Israel
Gal Bachar, MD (she/her/hers)
Rambam Healthcare Campus
Haifa, Israel
Chen Ben David, MD
Rambam Health Care Campus
Haifa, Israel, Israel
Yoav Siegler, BSc, MD
Rambam Health Care Campus
Haifa, Israel, Israel
Dana Vitner, MD
Rambam Health Care Campus
Yuval Ginsberg, MD (he/him/his)
Deputy Ob/Gyn department
Rambam Medical Health Campus
Haifa, Israel
RB
Ron Beloosesky, MD
Rambam Medical Health Campus
Haifa, Israel, Israel
ZW
Zeev Weiner, MD
Rambam Health Care Campus
Haifa, Israel, Israel
NK
Nizar Khatib, MD
Rambam Healthcare Campus
Acre, Hefa, Israel